Medicare Rule May Discourage Brain CTs in ED

Cheryl Clark, for HealthLeaders Media , October 20, 2011

"That will start to influence physicians' thinking, 'Well, should I even go down this road and get this CT because I'm just going to get in trouble?' 
These are the physicians who are going to miss a diagnosis."

Solomon says some doctors will order the CT, and if it's clear, continue with a lumbar puncture that will qualify the case for the reporting exclusion. And that will get them off the hook. However, Solomon foresees a problem with this approach too.

"The patient will say 'No thanks. Nobody's going to stick a needle in my spine.' Well, then the physician will say, 'Now what?' " he said.

The whole episode has left Solomon somewhat bitter.

"You look at the way CMS approaches quality and value, you can see that their focus really is on cost," he says. "Their focus really is in finding things they don't have to pay for."


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3 comments on "Medicare Rule May Discourage Brain CTs in ED"

Scott Stroming (10/22/2011 at 6:01 PM)
I would be happy to order fewer tests if the feds make it illegal to sue me

Steven Meyerson, MD (10/21/2011 at 12:49 AM)
There is solid evidence that brain CTs are of no value for patients with syncope who lack neurological signs or symptoms yet nearly all of them have a CT ordered. This applies to other neuro diagnostics ordered for syncope as well. This should be a target for eliminating unnecessary and harmful testing. It's not rationing. It's applying medical knowledge to overcome fear of being sued for not ordering a test - even if it has been proven to be useless.

W. C. Dandridge, Jr. M. D. MBA, FACS (10/20/2011 at 5:02 PM)
Well it's starting. Rationing of health care.




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